We are building a referral database

PatchSA receives regular requests from the public, looking for qualified healthcare professionals able to offer paediatric palliative care services in South Africa. We have also been approached by Discovery Health Medical Aid to provide a database of qualified healthcare professionals for their Advance Illness Benefit. Should you be willing for us to share your name and contact details for this purpose, please fill in and submit the form below and we will add you to our database of service providers.

Permission for referrals

Name(Required)
Please list your professional qualifications below.
Qualification in paediatric palliative care(Required)

If you are not registered with HPCSA or SANC please provide the name of the council with which you are registered
Please provide your council number
Type of support offered(Required)
Please mark which services you offer - you can mark more than one
Please describe your particular areas of expertise and/or specialisation.
Modes of support
Please provide the website address of your facility or organisation, if you have one.
Address(Required)
Permission(Required)